Maintaining optimal oxygen saturation in premature infants
Insights
Implementing a targeted oxygen saturation protocol significantly reduced severe retinopathy of prematurity (ROP) in preterm infants. This strategy lowered the incidence of ROP requiring laser surgery, improving outcomes and reducing healthcare costs.
Area of Science:
- Neonatal intensive care
- Pediatric ophthalmology
- Respiratory support in neonates
Background:
- Increasing survival rates of premature infants necessitate optimized respiratory support.
- Oxygen therapy is crucial but carries risks, including severe retinopathy of prematurity (ROP).
- High oxygen concentrations can cause irreversible eye damage and blindness in very-low-birth-weight preterm infants.
Purpose of the Study:
- To develop and implement strategies for reducing severe ROP in premature infants.
- To minimize the need for laser surgery in affected infants.
- To optimize oxygen titration protocols in neonatal intensive care units.
Main Methods:
- Studied 37 preterm infants (<32 weeks gestation, <1500 g birth weight) requiring supplemental oxygen.
- Monitored oxygen saturation (Spo2) trends, alarm limits, and incorrect settings.
- Implemented an Spo2 targeting protocol and an algorithm for fraction of inspired oxygen (Fio2) titration.
Main Results:
- Initial phase reduced Spo2 >95% to 20-50%, but wide fluctuations persisted.
- Second phase, with an Fio2 titration algorithm, reduced Spo2 >95% to 0-15%.
- Incidence of severe ROP requiring laser surgery decreased from 5 to 1 infant.
Conclusions:
- Maintaining targeted oxygen saturation levels significantly decreased severe ROP incidence.
- The optimized oxygen therapy protocol reduced the need for laser surgery.
- This practice change led to reduced hospital costs and shorter hospital stays for premature infants.
Introduction:
Advances in technology have resulted in increasing survival rates for premature infants. Oxygen therapy is commonly used in neonatal units as part of respiratory support. The number of premature infants in our institution surviving with severe (stage ≥3) retinopathy of prematurity (ROP) prompted a review of oxygen therapy as a contributing factor. Prolonged exposure to high concentrations of oxygen may cause irreversible damage to the eyes of very-low-birth-weight preterm infants and is a potential cause of blindness.
Objective:
We developed strategies to reduce incidence of severe ROP requiring laser surgery in premature infants.
Methods:
We studied 37 preterm infants who were born at a gestational age of <32 weeks, with a birth weight of <1500 g, receiving supplemental oxygen, and had been admitted to our neonatal intensive care unit. Infants received oxygen via mechanical ventilator, nasal continuous positive airway pressure (CPAP), or intranasal (I/N) and titration of oxygen was based on each infant's measured oxygen saturation (Spo(2)). For each infant, we monitored the Spo(2) trend, Spo(2) alarm limit, and the percentage of time that the alarm limit was set incorrectly. We implemented a Spo(2) targeting protocol and developed an algorithm for titrating fraction of inspired oxygen (Fio(2)).
Results:
After phase 1 of implementation, the percentage of time that Spo(2) readings were >95% was reduced to between 20% and 50%. However, our findings raised concern regarding the wide fluctuation of Spo(2) readings because of inconsistency in Fio(2) titration, which can contribute to deviation from the optimal target range. Accordingly, we developed an algorithm for titrating Fio(2) aimed at maintaining each infant's Spo(2) within the optimal target range. After phase 2 of implementation, the percentage of Spo(2) readings >95% was markedly reduced to between 0% and 15%. The incidence of infants with severe ROP requiring laser surgery decreased from 5 to 1.
Conclusions:
A change in clinical practice aimed at maintaining oxygen within the target range to avoid a high Spo(2) was associated with a significant decrease in the incidence of both severe ROP and the need for laser surgery, thus reducing hospital costs and length of hospital stays for premature infants.
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